The Silent, Deadly Epidemic of Non-Communicable Disease

CT scanners can be used to detect cancerous tumors. Photo by Flickr user Topsy Quret.

In 10 days, the United Nations will convene a high-level meeting on non-communicable diseases. The world’s global health news has been so dominated by infectious culprits — HIV/AIDS, malaria, tuberculosis, influenza — that it’s easy to forget just how big a toll conditions like diabetes, cancer and heart and lung disease take.

Roughly two out of every three deaths on the planet is now caused by non-communicable disease, and the U.N. estimates that by 2030, 52 million people will die annually from these diseases. That’s five times as many deaths as the estimated death toll for infectious disease.

Not all non-communicable diseases are linked to lifestyle choices, but many are exacerbated by poor diet, smoking, alcohol use, or environmental conditions. Obesity is a major risk factor for diabetes, heart disease and some types of cancers, creating a stereotype of these conditions as a rich country problem.

But the burden of non-communicable illness falls heavily on the poor. The death rate, by far, is highest in countries ranked as lower-middle income. The U.N. finds that the rates in lower-middle income countries come not from the fact that they have large populations, but rather from unplanned urbanization, aging populations, and even from rising incomes giving more people the ability to purchase tasty — but unhealthy — foods and smoke more cigarettes.

Young industrial powers like India and China are home to hundreds of millions who still earn their daily living from hard physical labor. At the same time, they are home to millions who grew up on the land, whose parents did that unremitting physical labor, and now spend their days sitting at benches assembling consumer goods, tending machines, or boxing finished goods. Along with smoking, alcohol use, and lousy diets, increasingly sedentary lives in the developing world has become a major source of ill health and early death.

Wait a minute, you might say…aren’t those the same problems faced by millions in the richest countries on earth?

Obesity, cardiovascular disease, cancer, diabetes…do these changes simply mean people in poor countries are becoming more like their brothers and sisters in the rich world? Sure, but with a key difference. In wealthy countries, individuals, insurance companies, and governments spend 10, 50, 100 times as much money per person on health care.

Watch a day of commercial television in the United States (if you can bear it). Hour after hour come a parade of advertising for drugs to lower blood sugar, cholesterol, blood pressure, stop plaque forming on blood vessels, aid in weight loss, relieve the symptoms of chronic obstructive pulmonary disease, or COPD. This is a crazy, slightly backwards way of treating non-communicable disease in the rich world, but we have decided we can afford it, and it turns out to be much easier that taking four inches off your waistline.

There is not enough money in the world to use drugs to treat non-communicable disease in the developing world. In the United States we are already reaping the whirlwind of rising health care costs due to non-communicable illness, with a per capita income approaching $50,000 a year.

The hard work of hundreds of millions of aspiring and struggling people in poor countries doesn’t just pay for better educations, cell phones, video games, and televisions. That new money pays for small indulgences. It pays for candy, ice cream, beer, cigarettes, and cheap motorcycles that belch blue smoke into the crowded
streets of the developing world.

Telling the people of this growing class, in Brazil, Indonesia, China, Russia, Mexico, South Korea and elsewhere, that they can’t enjoy the small pleasures they watched Westerners enjoy on syndicated TV and endless movies won’t work.

Encouraging moderation hasn’t worked particularly well in the wealthy world, either. The U.N. plans will urge education, awareness, and lifestyle change to face the threat from non-communicable disease. Small and under-funded national health and education systems will be asked to take to the streets, airwaves and schools to create a new consciousness.

And the stakes are high — on the streets of Caracas, Johannesburg, and Cairo there are kids starting to smoke who won’t be able to call on oncologists, high-tech diagnostic and therapeutic equipment to lengthen their lives.

For the millions of new obese, new seated factory workers there may not be another shot at getting it right. The world, even a world as full of suffering and early death as our own, is facing tens of millions of years of lost life from these diseases. We really have to do better.